Provider Demographics
NPI:1629494992
Name:VISHART, ANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:VISHART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 CHARLES RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2737
Mailing Address - Country:US
Mailing Address - Phone:617-924-0714
Mailing Address - Fax:
Practice Address - Street 1:358 CHARLES RIVER RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2737
Practice Address - Country:US
Practice Address - Phone:617-924-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist